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Women’s Health

Women’s Health. Prevention & Screening GYN Issues. Community Health Based Nursing. Research provides evidence that community-based nursing practice includes: Quality services that control costs Disease prevention/health promotion Partnerships/coalitions

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Women’s Health

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  1. Women’s Health Prevention & Screening GYN Issues

  2. Community Health Based Nursing Research provides evidence that community-based nursing practice includes: • Quality services that control costs • Disease prevention/health promotion • Partnerships/coalitions • Access to at-risk populations

  3. Community Health Based Nursing • Services to culturally diverse populations • Work with policy makers to change policy • Make environment healthier • Cultural competency • Outpatients/clinical settings • Service people across life span

  4. Primary Infection prevention S/S recognition Condom use Avoidance of douching Seeking medical attention quickly Secondary Treatment of UTI’s and pyelonephritis Early detection of cancer Treatment for high risk cervical cancer Community Health Based Nursing

  5. Menarche/Menstruation Anatomy/Physiology Dysmeonorrhea PMS/PMDD Know how body works Personal Hygiene Menopause Anatomy/Physiology Sexual concerns Diet/Exercise Calcium/Vit D supplement Prevention of discomforts Health Teaching

  6. Key Terms • Amenorrhea: Absence of menses • Dysmenorrhea: Painful menses Abnormal Uterine Bleeding • Menorrhagia: Heavy prolonged menses bleeding • Metorrhagia: Breakthrough bleeding (spotting)

  7. Pap Smears • Purpose: Screen for cervical cancer cells, dysplasia • Classification of Pap Tests: Bethesda System. • Negative/ASC-US/AGC/LSIL/HSIL/CIN123 • Initial should be done first year after sexual intercourse or by age 21, annual after that. • Involves scrapping the endocervix with a brush and spacula.

  8. Primary Painful, Cramping Period Prostaglandins are released during menstruation due to destruction of the endometrial cells due to increased activity of the uterine muscle with increased contractility and increased frequency of contractions Secondary Polyps, Fibroids,PID, Endometriosis, (uterine tissue growth into the wall of the uterus , Ovarian cysts, and pelvic congestion Menstrual ProblemsDysmenorrhea

  9. Primary Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen Oral contraceptives are second-line therapy Chiropractic care Acupuncture Secondary Identification and treatment of the underlying cause of the pain. (NSAIDs) Surgical Treatment of Dysmenorrhea

  10. PMS/PMDD Premenstrual Syndrome/Tension Premenstrual Dysphoric Disorder (severe symptoms) Symptoms: acne, bloating. fatigue, backaches, sore breasts, H/A, constipation, diarrhea, food cravings, depression/sad feelings, irritability, difficulty concentrating, difficulty handling stress. Symptoms start normally the week before menses starts

  11. PMS/PMDD • Diagnosis by symptoms and have woman journal for three months. • Treatment: Small freq. meals, decrease caffeine, carbs, sodium intake, sugars, stop smoking, increase exercise, increase calcium,Vit. D, Mag/Zinc, B6 Vits. Vit. E, Primrose Oil 500-1000mg QD, BCP, NSAID’s, BCP’s • With PMDD add Prozac (Sarafem) 10 mg 1 po Day 14-28,

  12. Vaginitis Vulvovaginal Candidiasis • Vaginal yeast infection caused by Candida albicans and non-albicans. • Affects the vulva and vagina • Symptoms: intense pruritis, erythema, dysuria, and thick curd like (cottage cheese) discharge. • Diagnosis: presenting c/o, physical findings, (KOH) wet mount (pseudohyphae) ph < 4.5 • Treatment: antifungal azoles

  13. Vaginitis cont. Bacterial Vaginosis • Caused by Gardnerella Vaginalis • Symptoms: fishy odor (especially after intercourse), thin grayish discharge, • Diagnosis: clue cells (epithelial cell invaded with bacteria) on wet mount, ph > 4.5, + whiff test, shows up on pap smear. • Treatment: Metrogel (Flaygl) If taking po’s no alcohol during or 24 hours after. Clindamycin • Risk: Can cause Preterm Labor, so treat!

  14. Vaginitis Trichomoniasis • Symptoms: profuse, frothy yellowish/green discharge, vulvavaginal irritation, dysuria, and dyspareunia • Treatment: Metronidazole

  15. Inflammatory Condition PID Pelvic Inflammatory Disease, infections and inflammation develop in pelvic organs. (Uterus, Fallopian Tubes, and Ovaries) • Complications: Ectopic pregnancy, pelvic abscess, infertility, chronic abdominal pain, pelvic adhesions, premature hysterectomy, and depression. • GC/gonorrhea are the two major causative organism (is also mixed infection of aerobic/anaerobic)

  16. PID cont. • Adolescents/Young Women are 3 x more likely to develop infection. • Risk Factors: Nonwhite Women, Multiple sex partners, sex during menses. • Diagnosis: CBC, ESR Rate to check for inflammatory process, pregnancy test,cervical cultures, U/S, Laparoscopy • Treatment: Regimen of antibiotics, pain meds possible surgery

  17. Inflammatory Condition Endometriosis • Presence of endometrial tissue at sites outside the endometrial cavity • Etiology unknown • Symptoms: Dysmenorrhea, pelvic pain. dyspareunia,intermenstrual bleeding, and infertility • Diagnosis: Laparoscopy • Treatment: NSAID’s, Progestogens, Danazol therapy for those who desire fertility. Corrective surgery

  18. Chlamydia Gonorrhea HPV Condylomata Acuminata (Genital Warts 6/11) HSV Type 1& 11 RPR/VDRL Syphilis Hepatitis B/C BV/Trichomoniasis HIV Sexually Transmitted Disease STD/STI’s

  19. STD’s cont. Gonorrhea/Chlamydia infection higher in teen world, hard to diagnosis. • Yellowish vaginal discharge and painful urination • Culture same time as Pap Smear taken • Untreated causes PID • Treatment: Zithromax/Rocephin and treat partner, use condoms until cure is confirmed

  20. STD’s cont. HPV 16 &18 70% of cervical cancers • Found on Pap requires further assessment with Colposcopy, possible LEEP procedure, Pap Q 4 months till normal pap results • Gardasil Vaccine: Age 9-26 studied • Series of 3 injections: now then in 2 months and then 4 months. (if tolerated Hep B Vaccine)

  21. STD’s cont. HSV 1 & 11 • Oral and Genital: Transmitted thru direct contact. • Asymptomatic vs. Symptomatic • Flu-like symptoms, painful sore/blister • Virus remains dormant in nerve ganglia, stress activated, fever, or menses • Rx. Antiviral (Valtrex)

  22. STD’s cont. Syphilis: painless Chancre on oral/lips, genitalia area, or anus. • Treatment: Penicillin (PCN) Bacterial Vaginosis:thin grayish white vaginal discharge, fishy odor, PH elevated • Rx. Metronidazole, Clindamycin Trichomoniasis: purulent, grey, yellow, malodorous vaginal discharge. • Rx. Tindamax, Metronidazole

  23. STD’s cont. HIV • Testing is offered to all pregnant women • No need for a consent anymore • No Cure • Research continues about the safety and benefits of drug regimens • AIDS info website/National Institute of Health

  24. Contraception Methods: Sterilization(Tubal Ligation and Vasectomy) Essure • Oral Birth Control: Combined/Mini Pill • Injections: Depo Provera/Rod Implant • Emergency: Plan B/Preven • Patch (Evra): Estrogen/Progesterone • Vaginal Ring (Nuva Ring): Combination • IUD: Copper (10yr)/Mirena (5yr)

  25. Contraception cont. • Implant (Implanon) Single Rod in upper arm • Barrier Method: Condoms, Diaphragm,Cervical Cap, Film/Foam/Sponge • Withdrawal • Abstinence • Natural Family Planning

  26. Contraception cont. Natural Family Planning • Calendar: Ovulation 14 days before menses • Basal Body Temperature: am temperatures, drop before ovul. Then rise with ovul. • Cervical Mucus/Billings Method (Ovulation) Mucus is clear, slippery,stretchy like egg whites. • Symptothermal Method: Combined all three

  27. Oral contraception (BCP) • Combined Estrogen/Progesterone • Progesterone only • Action: Inhibiting ovulation by suppressing FSH and LH from pituitary • Produces thick cervical mucus • Endometrium becomes less hospitable for implantation to occur

  28. Oral contraception • Improves Acne, PMS symptoms with some forms, Dysmenorrhea, Endometriosis, DUB, • Side Effects: nausea, vomiting, breast tenderness,breakthrough bleeding, water retention, mood changes

  29. Pill Start Instructions • Quick start on day they were prescribed • Check a pregnancy test first • Start on the first day of your period. • Start on the first Sunday after period • Use back up x 1 week into first pack • See instruction for missed pills

  30. Birth Control Pills • Danger Signs: ACHES • Abdominal pains (severe) • Chest pain or shortness of breath • Headaches (severe) • Eye problems, such as blurred vision • Severe leg or arm pain or numbness

  31. BCP Cautions Women who are over 35 and smoke or who have any of the following conditions should not take The Pill: • History of heart attack or stroke • Blood clots, DVT’s • Unexplained vaginal bleeding

  32. BCP Cautions • Known or suspected cancer • Known or suspected pregnancy • Liver disease • Women who are under 35 and smoke, have migraines, gallbladder disease, hypertension, diabetes, epilepsy, sickle cell disease, elective surgery, a history of blood clots, liver or heart disease may not be able to take The Pill.

  33. Birth Control • IUD: Copper/Mirena 10yr/5yr • Causes a sterile inflammatory response/spermicidal intrauterine environment. • Insert anytime when woman is not pregnant • Does not cause eptopic pregnancies • Check for infections/pap prior to insertion • SE: cramping, bleeding (spotting) for 2-3 months. Complications: expulsion/perforation of uterus • Teach string check to be done every month

  34. Progesterone Only • Depo-Provera use for 2 or more years can cause bone loss, which may not be fully reversible after stopping the medication.6Bone loss can lead to osteoporosissis in later life, which makes bones weak enough that they are more likely to break. • For teens, bone loss from Depo-Provera is a big concern. Teens are normally building bone mass as they grow. This is why it is more important than ever for teens to get enough calcium and vitamin D when using Depo-Provera.

  35. Progesterone Only • Mini Pill is good alternative for woman who is breast feeding • Diagnosed with Hypertension • Unable to tolerate Estrogen • Depo Provera: good for those who aren’t good pill takers, breast feeding moms. IM Injection 150 mg every 12 weeks

  36. Violence Against Women • Domestic Violence • Rape (Date Rape) • Verbal vs. Nonverbal, Work Sexual Harassment • Physical (Injuries difficult to see, check between legs, area are covered up) • Vague complaints • Battered Women Syndrome • Occurs in lower socioeconomic • Drugs and Alcohol

  37. Violence Against Women cont. • Counseling • National Domestic Violence Hotline: 800-799-7233 Hotline available 24 hours a day, 7 days a week. • Rape, Abuse & Incest National Network (RAINN): (800) 656-HOPE (4673)Hotline available 24 hours a day, 7 days a week. The RAINN hotline automatically connects callers to hotlines run by rape services organizations near the caller.For more information check their website at www.rainn.org.

  38. Infertility Perimenopause Menopause Surgeries Breast Health Heart Disease UTI”s Women’s Health to be continued,

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